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论著 　　作者单位:510515广州, 南方医科大学南方医院消化内科研究所通讯作者:姜泊, Email :drjiang@163. com结直肠锯齿状腺瘤内镜和病理形态特征分析张婉雯 　任宝军 　童华生 　张亚历　姜泊　　【摘要】　目的　探讨锯齿状腺瘤(SA)内镜下形态和病理组织学特征。 方法 　回顾分析南方医院消化内镜中心 2002年 1月至 2005年 7月检出的大肠息肉病例, 了解 SA 的检出率、内镜形态、腺管开口分型和病理组织学特征。 结果　11 894例肠镜检查共检出息肉病例 1928例(2811枚), 检出率为 16.21%, 其中 SA 61例(71枚), 检出率为 0.51%, 占息肉构成比为 3.16%。 SA 直径 >1 cm者占39.44%, 明显大于增生性息肉;内镜下表现为有蒂息肉所占的比例 (26.76%)高于增生性息肉(13.25%), 但低于腺瘤性息肉(43.95%)。 1815枚息肉进行腺管开口分型, SA 多表现为Ⅲ型腺管开口(41.67%), 部分表现为Ⅳ型腺管开口(18.33%), 与腺瘤性息肉较接近。 SA中度以上异型增生发生率介于管状腺瘤和绒毛状腺瘤之间, 并有 2.82%的癌变率。 结论　SA内镜形态、腺管开口分型和病理学特点提示其本质上与增生性息肉不同, 与肿瘤性息肉表现类似, 具有恶变潜能。　　【关键词】　锯齿状腺瘤;　增生性息肉;　腺瘤性息肉Analysis of the characteristics of endoscopic and histopathological features of colorectal serrated ade-nomas　ZHANGWan-wen, REN Bao-jun, TONG Hua-sheng, ZHANG Ya-li, JIANG Bo. The Insititute forDi-gestiveMedicine, Nanfang Hospital, SouthernMedicalUniversity, Guangzhou510515, ChinaCorresponding author:Jiang bo, Email:drjiang@163. com　　【Abstract】　Objective　To explore the endoscopic and histopathological features of serrated adeno-mas(SAs). M ethods　The data of patients with colorectal polyps diagnosed in the D igestive EndoscopyCenter atNanfang Hospital from January 2002 to July 2005 were reviewed and the detection rate, endoscopicappearances, pit patterns and histopathological features of SA swere analyzed. Results　In 1928(16.21%)out of11 894 patientsundergoing colonscopy 2811 polypswere found. Among them 61 patientswith 71 polypswere found, w ith a detection rate of0.51%. The SAs, larger than hyperplastic polyps obviously, were found inpatients 39.44% with diameter ( larger than 1 cm). The incidence of pedunculated polyps in SA s(26.76%) was higher than that in hyperplastic polyps(13.25%), but less than in adenomatous polyps(43.95%). The pit patterns of SA s, were typeⅢ pit pattern (41.67%) and type Ⅳ pit pattern(18.33%), this resultwas si milar to adenomatous polyps. The incidences ofmoderate and severe dysplasiaofSA swere higher than those of tubular adenomas but lower than villous adenomas. The canceration rate ofSA was 2.82%. Conclusion　The endoscopic appearances, these of pit patterns and histopathological fea-tures ofSA s, were different from hyperplastic polyps essentially, but si m ilar to neoplastic polypsw ith poten-tialmalignancy, which should be emphasized in clinical practice.　　【Keywords】　Serrated adenoma;　Hyperplastic polyp;　Adenomatous polyp　　Urbanski等[ 1]于 1984年首先报道了 1例兼有增生性息肉形态学特征和腺瘤性息肉组织学特点的息肉。 1990年 Longacre等[ 2]对这类息肉在病理组织学方面做了详尽的研究 , 将其命名为混合型增生性腺瘤性息肉或锯齿状腺瘤 (m ixed hyperplastic ade-nom atous polyps /serrated adenomas, MHAP /SA), 并建议以“锯齿状腺瘤 ”诊断该类病变 。此后, SA 作为一类独特的结直肠上皮源性肿瘤引起病理学家及内镜学家们的重视。 Jaramillo等[ 3]研究表明小的SA内镜下形态与增生性息肉相似 , 因此, 不能认为表现为增生性息肉特征的小息肉都是良性的, 它们可能是 SA并具有一定的恶变潜能 。我国对于 SA— 81 — 中华消化内镜杂志 2006年 4月第 23卷第 2期　Chin JD ig Endosc, April 2006, Vol 23, No.2